Objective:To assess the availability of essential health services in northern Liberia in 2008; five years after the end of the civil war. Methods We carried out a population-based household survey in rural Nimba county and a health facility survey in clinics and hospitals nearest to study villages. We evaluated access to facilities that provide index essential services: artemisinin combination therapy for malaria; integrated management of childhood illness; human immunodeficiency virus (HIV) counselling and testing; basic emergency obstetric care and treatment of mental illness. Findings Data were obtained from 1405 individuals (98response rate) selected with a three-stage population- representative sampling method; and from 43 of Nimba county's 49 health facilities selected because of proximity to the study villages. Respondents travelled an average of 136 minutes to reach a health facility. All respondents could access malaria treatment at the nearest facility and 55.9could access HIV testing. Only 26.8; 14.5; and 12.1could access emergency obstetric care; integrated management of child illness and mental health services; respectively. Conclusion Although there has been progress in providing basic services; rural Liberians still have limited access to life-saving health care. The reasons for the disparities in the services available to the population are technical and political. More frequently available services (HIV testing; malaria treatment) were less complex to implement and represented diseases favoured by bilateral and multilateral health sector donors. Systematic investments in the health system are required to ensure that health services respond to current and future health priorities.

Objective:To assess the availability of essential health services in northern Liberia in 2008; five years after the end of the civil war. Methods We carried out a population-based household survey in rural Nimba county and a health facility survey in clinics and hospitals nearest to study villages. We evaluated access to facilities that provide index essential services: artemisinin combination therapy for malaria; integrated management of childhood illness; human immunodeficiency virus (HIV) counselling and testing; basic emergency obstetric care and treatment of mental illness. Findings Data were obtained from 1405 individuals (98response rate) selected with a three-stage population- representative sampling method; and from 43 of Nimba county's 49 health facilities selected because of proximity to the study villages. Respondents travelled an average of 136 minutes to reach a health facility. All respondents could access malaria treatment at the nearest facility and 55.9could access HIV testing. Only 26.8; 14.5; and 12.1could access emergency obstetric care; integrated management of child illness and mental health services; respectively. Conclusion Although there has been progress in providing basic services; rural Liberians still have limited access to life-saving health care. The reasons for the disparities in the services available to the population are technical and political. More frequently available services (HIV testing; malaria treatment) were less complex to implement and represented diseases favoured by bilateral and multilateral health sector donors. Systematic investments in the health system are required to ensure that health services respond to current and future health priorities.

Introduction: Malaria, a public health problem in tropical countries, depends on several factors, some of which are social and environmental. In Mali in the Sahel zone, a socio-security crisis has prevailed in recent years. It was therefore interesting to study the epidemiology of this condition in situation. Objective: To determine the frequency of malaria among febrile syndromes in children aged 1 to 59 months in the pediatric ward of the Regional Hospital of Timbuktu. Material and methods: the study was longitudinal retrospective descriptive for a period from January 1 to December 31, 2015. The data were collected with fact sheets and consultation records. They were captured and analyzed on the Statistical Package for Social Scientist (SPSS) software version 21. Results: a total of 789 children hospitalized, 276 children had a febrile syndrome (35%). During the study period, we collected 180 cases of malaria, with a positive biological examination. The hospital frequency of malaria was 22.8% (180/789) and a frequency in febrile syndromes of 65.2% (180/276) of malaria cases. Of these 180 cases, 147 cases of uncomplicated malaria (81.7%) and 33 cases of severe malaria (18.3%) were found. In 34.8%, the etiology of febrile syndromes was other than malaria. Seasonal variation in malaria was found in terms of months of the year, peaking in September. The hospital lethality was 1.1% in our series. Conclusion: Malaria was the leading febrile syndromes among children under 5 in hospitals in Tombouctou.

Introduction: Malaria, a public health problem in tropical countries, depends on several factors, some of which are social and environmental. In Mali in the Sahel zone, a socio-security crisis has prevailed in recent years. It was therefore interesting to study the epidemiology of this condition in situation. Objective: To determine the frequency of malaria among febrile syndromes in children aged 1 to 59 months in the pediatric ward of the Regional Hospital of Timbuktu. Material and methods: the study was longitudinal retrospective descriptive for a period from January 1 to December 31, 2015. The data were collected with fact sheets and consultation records. They were captured and analyzed on the Statistical Package for Social Scientist (SPSS) software version 21. Results: a total of 789 children hospitalized, 276 children had a febrile syndrome (35%). During the study period, we collected 180 cases of malaria, with a positive biological examination. The hospital frequency of malaria was 22.8% (180/789) and a frequency in febrile syndromes of 65.2% (180/276) of malaria cases. Of these 180 cases, 147 cases of uncomplicated malaria (81.7%) and 33 cases of severe malaria (18.3%) were found. In 34.8%, the etiology of febrile syndromes was other than malaria. Seasonal variation in malaria was found in terms of months of the year, peaking in September. The hospital lethality was 1.1% in our series. Conclusion: Malaria was the leading febrile syndromes among children under 5 in hospitals in Tombouctou.

Objective : To rapidly increase childhood immunization through a preventive, multi-antigen, vaccination campaign in Mambéré-Kadéï prefecture, Central African Republic, where a conflict from 2012 to 2015 reduced vaccination coverage. Methods:The three-round campaign took place between December 2015 and June 2016 using: (i) oral poliomyelitis vaccine (OPV); (ii) combined diphtheria, tetanus and pertussis (DTP) vaccine, Haemophilus influenza type B (Hib) and hepatitis B (DTP–Hib–hepatitis B) vaccine; (iii) pneumococcal conjugate vaccine (PCV); (iv) measles vaccine; and (v) yellow fever vaccine. Administrative data were collected on vaccines administered by age group and vaccination coverage surveys were carried out before and after the campaign.Findings:Overall, 294 054 vaccine doses were administered. Vaccination coverage for children aged 6 weeks to 59 months increased to over 85% for the first doses of OPV, DTP–Hib–hepatitis B vaccine and PCV and, in children aged 9 weeks to 59 months, to over 70% for the first measles vaccine dose. In children aged 6 weeks to 23 months, coverage of the second doses of OPV, DTP–Hib–hepatitis B vaccine and PCV was over 58% and coverage of the third doses of OPV and DTP–Hib–hepatitis B vaccine was over 20%. Moreover, 61% (5804/9589) of children aged 12 to 23 months had received two PCV doses and 90% (25933/28764) aged 24 to 59 months had received one dose.Conclusion:A preventive, multi-antigen, vaccination campaign was effective in rapidly increasing immunization coverage in a post-conflict setting. To sustain high coverage, routine immunization must be reinforced.

Objective : To rapidly increase childhood immunization through a preventive, multi-antigen, vaccination campaign in Mambéré-Kadéï prefecture, Central African Republic, where a conflict from 2012 to 2015 reduced vaccination coverage. Methods:The three-round campaign took place between December 2015 and June 2016 using: (i) oral poliomyelitis vaccine (OPV); (ii) combined diphtheria, tetanus and pertussis (DTP) vaccine, Haemophilus influenza type B (Hib) and hepatitis B (DTP–Hib–hepatitis B) vaccine; (iii) pneumococcal conjugate vaccine (PCV); (iv) measles vaccine; and (v) yellow fever vaccine. Administrative data were collected on vaccines administered by age group and vaccination coverage surveys were carried out before and after the campaign.Findings:Overall, 294 054 vaccine doses were administered. Vaccination coverage for children aged 6 weeks to 59 months increased to over 85% for the first doses of OPV, DTP–Hib–hepatitis B vaccine and PCV and, in children aged 9 weeks to 59 months, to over 70% for the first measles vaccine dose. In children aged 6 weeks to 23 months, coverage of the second doses of OPV, DTP–Hib–hepatitis B vaccine and PCV was over 58% and coverage of the third doses of OPV and DTP–Hib–hepatitis B vaccine was over 20%. Moreover, 61% (5804/9589) of children aged 12 to 23 months had received two PCV doses and 90% (25933/28764) aged 24 to 59 months had received one dose.Conclusion:A preventive, multi-antigen, vaccination campaign was effective in rapidly increasing immunization coverage in a post-conflict setting. To sustain high coverage, routine immunization must be reinforced.